USA TODAY and HBO are collaborating on a special report on drug and alcohol addiction. This story is part of that project, which will include future reports in USA TODAY and a two-hour HBO public service special scheduled to air in March 2007. We will explore the latest research on addiction, how addiction affects lives and communities, and cutting-edge treatments.

If not for his wife and four children, Tim Ryan says matter-of-factly, he'd be dead.

Ryan, 37, estimates he has been sober, on and off, for eight of the past 16 years. He says his most recent stint began about six months ago, when he stopped drinking and using heroin. This time, he says, sobriety is going to stick.

"I spend a majority of my time with my kids," says Ryan, a partner in a Chicago information technology company who often works from his suburban home. "I look at their eyes and their faces. If I can't quit for them, I've got a problem."

Addiction is endemic in American families. A USA TODAY/HBO nationwide poll of adults April 27-May 31 found that one in five said they had an immediate relative who at some point had been addicted to alcohol or drugs. That translates into roughly 40 million American adults with a spouse, parent, sibling or child battling addiction. And that doesn't count the millions of children living with an addicted parent.

Many Americans might find these numbers shocking. But H. Westley Clark, who directs the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration, or SAMHSA, says he's not surprised that 20% of poll respondents said they have an immediate relative who has been addicted to alcohol or drugs.

"I don't think that's particularly high," says Clark, a psychiatrist and lawyer. "Roughly half of American adults drink alcohol. You're dealing with a large number here."

Addiction is a family disease. Even if only one member is addicted to alcohol or drugs or both, all are affected. And unless addiction is dealt with as a family problem, marriages will be destroyed, and children will be at risk of repeating the cycle.

"For every person who's alcoholic or dependent on other drugs, there are at least four or five people hurt on a regular basis," says Sis Wenger, executive director of the National Association for Children of Alcoholics.

Pay attention to those four or five people as well as their addicted family member, and you increase the likelihood of a successful recovery, says Charles Curie, administrator of SAMHSA, which is part of the Department of Health and Human Services.

"More and more, you're unable to make a real impact on someone's addiction unless the family as a whole is considered," he says.

When asked for words or phrases that described addiction's effect on their family, survey respondents came up with "devastating," "abusive" and "bitter," among others. In interviews taken during the poll, the survey respondents described life with an addicted family member.

One now ex-husband says he called every drugstore within 50 miles of his home to ask pharmacists to stop filling his wife's painkiller prescriptions because she was getting duplicates from various doctors. Another spoke of how his now ex-wife would crack open a beer as soon as she got home from work and, on weekend mornings, practically as soon as she got out of bed.

Not surprisingly, when one spouse drinks heavily and the other doesn't, chances of divorce are high, says Kenneth Leonard, a senior scientist at the Research Institute on Addictions at the University at Buffalo.

But when both are heavy drinkers, researchers have found that they tend to be fairly satisfied with their marriage, says Leonard, whose research into the effects of alcoholism on marriages and children is financed by the National Institute on Alcohol Abuse and Alcoholism.

When only one spouse drinks heavily or uses drugs or does both, chances are it's the husband. In the USA TODAY/HBO poll, which was conducted by Gallup and had a margin of error of plus or minus 4 percentage points, 31% of women who had an addicted relative mentioned their spouse, compared with only 12% of men.

Tim Ryan says his wife, Shannon Ryan, 35, "barely drinks." Ask her to describe life over the years with her husband, and the word "turmoil" pretty much sums it up. When he was using drugs or drinking heavily, she says, "he was not a father, he was not a husband, he was not a friend. He was just someone who existed and brought home a paycheck."

They met when she was hired as the office administrator at his company, where he worked as director of recruiting. "I had told him the first date we went on if he was involved in drugs in any way, let me know, because I didn't want to continue with him," she recalls. "He lied to me."

Before they were married in December 1996, Shannon Ryan says, "I knew he had the alcohol issues. I didn't even change my last name for a while. A good way to start a marriage, knowing you're going to be divorced right away."

They were married at the courthouse. She was pregnant with their first child together (Ryan eventually adopted her firstborn son from a previous relationship). He was hung over, the couple say.

After their son was born, Shannon Ryan says, she began hyphenating her maiden name and her husband's last name "so I could at least be associated with him (her son) when he went to school."

Around that time she found cocaine on a shelf in the garage.

"At first, he denied it: 'It's not mine, it's a friend's.' But after a while, he admitted it," she recalls. "I was blind for a couple of years, but now the pieces were starting to fit." She'd noticed money disappearing. Now she knew why.

"And it really wasn't too long after that that he got clean for a while, for about a year," she says. "I wanted to think it would be forever, but I knew deep down it was a temporary thing. I just kind of knew that he would eventually fall.

"I think in the back of his head he had the goal, 'I'm just going to do it for a year.' "

And then their firstborn child, at age 6, was struck by a car. The boy, who is now 12, had surgery and spent a week in the hospital, followed by weeks of recuperating at home. Shannon Ryan, who was interviewed separately from her husband, figures that the accident served as a convenient reason for him to fall back into his old habits.

Over the next several years, during which their family grew by two, "he had brief moments here and there of being clean or sober," Ryan's wife recalls. "Usually, he would either drink, or he would do drugs. It was rarely combined."

Eventually, he began using heroin. "Heroin is so different from cocaine or alcohol," Shannon Ryan says. "It has such a different grab on him. It's uncontrollable."

Working at home probably helped her husband keep his recruiting job, she says. "He could use here at home. He could go out and get the heroin, and no one knew he was gone."

She says she would take him to the train station so he could go downtown to interview job candidates. Or so she thought. "This went on for two years before I realized what he was doing," she says. Besides wining and dining job prospects, her husband admits, he also was meeting drug dealers to buy heroin.

Although Ryan says he has made "well over" $100,000 each year of his marriage, his addiction left them broke. "Drugs and alcohol came first, and the bills came second," Shannon Ryan says.

They had a car repossessed, then a boat. "I had several loans go into default," she says.

"I had to borrow money to pay our electric bills. It was just sickening, making the amount of money he did. We couldn't get credit for anything."

Women pay the price

In the USA TODAY poll, women were significantly more likely than men to say that a family member's addiction had hurt their mental and physical health and their marriage, and Shannon Ryan is no exception. As a result of her husband's addiction, she says, she developed an ulcer and began taking an antidepressant.

Ryan says he can't understand why she stayed with him. She acknowledges: "I thought about leaving him a lot. To be honest, I felt really trapped, being that he was the breadwinner. I didn't have a job. I had four small children. I really couldn't go out and get a job."

So she stayed home and covered for her husband. Ryan says he frequently broke promises to take their kids to the park or to the zoo.

"The kids would be disappointed, and then I would have to pick up the slack," Shannon Ryan says. "I would have to make up excuses for him. I was doing a lot of lying to the kids."

They were young, but they weren't oblivious, she says. "The oldest one, especially. He would know when Tim was drunk, for sure. He would know when Tim was high on cocaine."

The toll on children

A nationwide household survey in 2003 found that 6 million children in the USA lived with at least one parent who abused or was addicted to alcohol or drugs during the previous year, SAMHSA director Curie says. "Children who are in critical developmental phases, who are quite young, can be profoundly impacted."

In one study, Leonard of the University at Buffalo found that among fathers of 12-month-olds, those who abused alcohol spoke less to their children and expressed less positive involvement. They also felt more negative emotions and aggravation when it came to their children. By 18 months old, children of fathers who abused alcohol had more symptoms of anxiety and depression than their peers, Leonard found.

If no one intervenes, about one in four children of alcoholics become alcoholics themselves, says Wenger of the National Association for Children of Alcoholics.

"There's a very disproportionate number of people growing up in those families who end up with addiction or abuse," she says. "These children are so good at looking OK that they fool their parents, they fool their teachers. Then they graduate from college and repeat the cycle."

Her organization works with clergy, teachers and pediatricians to identify children whose parents are addicted to alcohol or drugs.

"It's a phenomenal number of children, and they all think they're alone," Wenger says. "These children can get better, even if their parents don't, if they get the right education and support."

One of the most important lessons for these children is that alcoholism is a disease, not a shameful family secret they must keep, Wenger says. "It's almost palpable, when you're working with these kids, when they get it: 'Oh my God, it's not my fault.' "

Some addiction treatment programs involve the entire family. One of the first was Seabrook House, an inpatient treatment center in Bridgeton, N.J., which runs the yearlong MatriArk program for low-income single mothers who are dealing with addiction.

Established in 1993 with funding from SAMHSA, MatriArk opened a new $8.3 million complex in May. It contains 36 apartments of various sizes for the women and their children 12 and under, who usually join their mothers a month into treatment.

Preschoolers attend MatriArk's day care program, which specializes in working with children who have developmental problems related to their mother's drug or alcohol use. Older children go to the nearby public elementary school.

Besides treating the mothers' addiction, MatriArk teaches them how to be loving, responsible moms, says Seabrook House president Edward Diehl. They are typically daughters of single mothers who themselves were addicted, Diehl says. "Our goal is to try and not repeat the cycle in the next generation."

Ryan says fear of losing his wife and children finally drove him to go on methadone for his heroin addiction nearly a year and a half ago. "If I would have kept on the path I was, she would have left me."

He eventually switched to buprenorphine, another drug used to treat opioid addiction. Many doctors regard buprenorphine as long-term treatment for the chronic disease of addiction, but Ryan decided on his own to stop taking it after a month and a half. He says he was concerned that the longer he took it, the more difficult it would be to stop taking it.

He doesn't go to Alcoholics Anonymous meetings regularly but says he frequently talks to his AA sponsor. Ryan says he also seeks support in online recovery forums.

In the USA TODAY/HBO poll, three out of four respondents with addicted close relatives said they thought their family member could make a full recovery. However, two-thirds of them thought recovery was possible only with professional help.

Can Tim Ryan succeed?

In Ryan's favor, says Clark of SAMHSA, is the fact that he is married and has children and says he has cut his ties with substance abusers. "You're always at risk for relapse, but that doesn't mean you will relapse," Clark says.

Shannon Ryan is cautiously optimistic about her husband's chances for a long-term recovery.

"Part of it now is the kids are older, and I'm not as dependent on him anymore," she says. "I'm hopeful he's a little more fearful of falling again."

Ryan knows he has given his wife every reason to be skeptical.

"I think a lot of times she sits there going, 'When's the other shoe going to drop? Is this for real?' " he says.